IN WOMEN WITH ADVANCED CERVICAL

A REPORT OF TWO CASES AND REVIEW OF LITERATURE

Christine Joyce P. Maningas-Omolida1, Maria Concepcion Ilao-Oreta2, and Virgilio M. Novero, Jr. 3,4

1 Fellow-in-training, Section of , St. Luke’s Medical Center Quezon City 2 Active Consultant, Section of Reproductive Medicine, St. Luke’s Medical Center Quezon City 3 Associate Professor, Section of Reproductive Endocrinology and , Department of Obstetrics and Gynecology, 4 University of the Philippines College of Medicine, UP Manila 4 Head, Center for Advanced Reproductive Medicine and Infertility, St. Luke’s Medical Center Global City

INTRODUCTION

BACKGROUND AND AIM

Cervical cancer is a prevalent malignancy among Filipino women1. Patients are usually managed with radiotherapy and concurrent . Unfortunately, the risk of gonadal damage from cancer treatment is extremely high2 and suitable options for fertility preservation remain as a major concern among those who still desire future reproduction despite the cancer. The aim of this paper is to report two cases of women with advanced cervical cancer who underwent fertility preservation procedures and to discuss the available and appropriate treatment options for fertility preservation among such women.

Table 1. Two Cases of Cervical Cancer Requiring Fertility Preservation METHODS

Two cases of young women with advanced cervical cancer who both desired fertility preservation were identified. Using PUBMED, a literature search and review was conducted regarding the expected reproductive damage after cancer treatment and the recommended fertility preservation options in such cases.

RESULTS Image 1. Embryo Cryopreservation for Patient A

The two cases of advanced cervical cancer requiring fertility preservation are summarized in Table 1. Both cases underwent combined embryo cryopreservation (Image 1 and 2) and ovarian tissue cryoreservation. Both cases achieved cancer remission but there was no ovarian and uterine function after chemoradiation including the second case wherein ovarian transposition was performed. The first case achieved a pregnancy and livebirth using a surrogate carrier, whereas additional fertility treatment for the second case is still pending. According to literature, embryo cryopreservation with frozen embryo transfer through a surrogate has been the best-established and most widely used method Image 2. Embryo Cryopreservation for Patient B of fertility preservation in such women4. The success of ovarian tissue cryopreservation with transplantation and ovarian transposition are still limited but REFERENCES may be an option for fertility preservation4.

1 Ferlay J, Ervik M, Lam F, Colombet M, Mery L, Piñeros M, Znaor A, Soerjomataram I, Bray F(2018). Global Cancer Observatory: Cancer Today. Lyon, France: International Agency for Research on Cancer. Available from: CONCLUSION https://gco.iarc.fr/today, accessed [05 Oct 2019]. 2 Kim, Sooyoung et al. Ovarian Tissue Cryopreservation and Transplantation in Patients with Cancer. Obstetrics & Gynecology Science. 2018; 61 (4): 431-442 Fertility preservation among young women with advanced cervical cancer 3 Feichtinger M et al. Fertility Preservation in Women with Cervical, Endometrial or Ovarian . Gynecologic Oncology Research and Practice. 2016; 3:8. should be one of the goals of cancer treatment. However, because of the severe 4 Oktay K et al. Fertility Preservation in Patients with Cancer: ASCO Clinical Practice Guidelines Update. Journal of reproductive damage after chemoradiation, couples need to be counseled that Clinical Oncology. 2018; 36: 1994-2001.

5 fertility treatment using a surrogate is a likely option in such cases. Von Wolff M et al. Practical Recommendations for Fertility Preservation in Women by the FertiPROTEKT Network. Part I: Indications for Fertility Preservation. 2017; 297 (1) 241-255.

6 Von Wolff M et al. Practical Recommendations for Fertility Preservation in Women by the FertiPROTEKT Network. Part II: Fertility Preservation Techniques. Archieves of Gynecology and Obstetrics. 2018; 297:257-267.

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